Laser Eye Center of Silicon Valley

Presbyopia is the aging change in the lens of the eye that occurs during the early 40's, causing a need for reading glasses. It happens to everyone, and the "cure" for presbyopia is the holy grail of refractive surgeons and patients everywhere.

People who are nearsighted are able to see near, even if they are older and have presbyopia. That is why if you are nearsighted you can take your glasses or contacts off and see close up, even if you are in your 50's. Monovision uses this fact to allow you to see up close without glasses after surgery, however there are tradeoffs with monovision.

A true surgical reversal of presbyopia without doing monovision is being worked on. There are two basic approaches to this type of treatment-the first tries to restore natural focusing ability to the lens, and the second uses a principle called multifocality to achieve near vision.

Restoring natural focusing ability to the lens is being attempted with a procedure called Surgical Reversal of Presbyopia, or SRP. SRP involves the placement of tiny implants in the sclera (the white part of the eye), similar to putting a belt through belt loops. These implants are known as Scleral Expansion Bands. Results at this point are mixed-some patients get some effect and many others get no effect.

Other procedures along the same vein include Laser Presbyopia Reversal (LAPR) surgery with the Surgilight laser, an infrared laser which ablates sclera. A non-laser form of this technique is called Anterior Ciliary Sclerotomy, or ACS. ACS results have been poor to date, but some surgeons are working on a modification of the technique, using spacers inside the incisions to prevent the regression of effect that is typically seen.

Some lens implants originally designed for use in cataract surgery are being modified to try to allow for reversal of presbyopia. Accommodative IOLs are implants with tiny hinges that allow movement of the lens inside the eye, which optically can allow for some near vision.

Multifocal approaches to presbyopia include placement of multifocal intraocular lenses like the AMO Array lens, or small circular implants placed in the cornea either in a pocket created, or under a flap. Other work being done focuses on multifocal cornea ablations using LASIK or PRK, to attempt to create a "bifocal" effect in the cornea.

Accommodative IOLs coming a long way